Objective To present a method to treat soft tissue defects with bone exposure after the distal tihial fracture.Methods Twenty-six patients who had suffered from the distal tibial fracture complications leading to exposure of the bone or fixation material sought medical help in our department.The internal fixation material was removed and radical revision of dead and infected tissue was carried out in all cases.Five of the 26 cases were treated using a free microvascular muscle flap and the mesh skin graft by one stage.Twenty-one of them were re- paired with the same method by two-stage.Results Follow-ups were 10 to 24 months.The microvascular re- construction was successful in 22 patients.Two of the 26 cases had partial necroses of the skin graft,and the other two cases had delayed wound healing.All the fractures united.Conclusion Microvascular free muscle flap re- construction of the leg is regarded as a reliable method to treat legs with massive soft-tissue defects or defects with bone exposure and chronic infection or fistulation at the distal leg.

Objective To study the protection and mechanism of co-administration of vitamin E with coenzyme Q10(CoQ10) to valproate-associated hepatotoxicity in infantal rats.Methods The rat models were established by oral administration of valproic acid(VPA) in ablactation(21 days) Wistar rats,at doses of 500 mg/(kg?d) during 30 days,other groups received the same amount of VPA with phemobarbitone(PB) and co-administration with vitamin E and CoQ10.The changes of liver cell morphology and the blood coagulation test,as well as the contents of succinic dehydrogenase(SDH),cytochrome oxidase(CCO),cytochrome,the levels of glutothione(GSH) and malondial dehyde(MDA) in rat liver mitochondria were detected by chromatometry,HPLC,Oil-Red-O staining and electron microscope,respectively.Results 1.Average content of cytochrome aa3 in liver mitochondria of infantal rats were reduced by 58.80% and(61.80%) because of administration of VPA and VPA added with PB.The protection against the loss of cytochrome aa3 by coadministration of VitE and CoQ10 was obvious.As for activities of SDH and CCO,which affected by VPA and VPA added with PB in rats,were significantly lowered compared with control group(P

Premium healthcare is the key area of healthcare industry and private medical institutions. Howev-er, with the expansion of VIP services in public hospitals and policy barriers to private medical institutions, the de-velopment of premium healthcare in China is still in its early stage. The premium healthcare industry has in fact be-gun to take shape in some developed countries, accumulating rich experience in the aspects of developing bases, op-erating modes and security systems. Therefore, this paper introduces the experiences of premium healthcare develop-ment in several countries:the United Kingdom, the United States, Germany, Singapore, Australia, and India: the building of safety net hospitals;the setting of hierarchical pricing and differential financial assistance;the use of pub-lic-private partnership based on commercial health insurance to determine prioritization. Based on the actual situation in China, this paper provides some implications to develop premium healthcare, including the implementation of dif-ferential payment policies built on the provision of basic healthcare services, the promotion of commercial health in-surance and public-private partnerships, and the determination of preferential areas.

Premium healthcare is one of the major components of private healthcare, a key part of the health service industry, and one of the significant areas of the Thirteenth Five-Year Plan of health. However, there is no clear definition of premium healthcare that is widely accepted based on a Chinese literature review, and to define the concept of premium healthcare is the basis and premise for research. This paper adopted the methods of systematic re-view, field investigation and key person interviews to clarify the definition of premium healthcare and the results sug-gested that areas of health management, medical care for the elderly, mobile medical care, and so on should be the priorities of premium healthcare development.

Objective:To analyze status quo and trends of VIP services in the tertiary public hospitals of Shang-hai and provide references for health administrative departments. Methods:Health policies of VIP services in tertiary public hospitals were searched and analyzed, and the number of medical institutions, services, prices and service fees were analyzed from 2011 to 2013 . Results:There is a clear demand for VIP services in the tertiary public hospi-tals of Shanghai, and fees for rooms, nursing, and examinations for outpatient and inpatient care are decided by the hospitals. 89. 7% of the tertiary public hospitals in Shanghai offered VIP services, and the trend was steadily grow-ing. The four services that could be decided by hospitals varied greatly, and the service fees for inpatient care in-creased significantly. The total cost of VIP services in the tertiary public hospitals of Shanghai accounted 6. 2% of all costs, and the percentage of income from drugs was lower. Conclusions:VIP services in public hospitals have a his-torical necessity;management should be strengthened in the short term;public hospitals should strengthen their own management and provide VIP services regularly, and health administration departments should strengthen regulation. In the long run, it is suggested that public hospitals should draw lessons from international experiences to form a pat-tern of multi-level medical services and actively carry out cooperation with private medical institutions.

Objective:To study status quo of premium private health services and analyze the trend of its devel-opment. Method:The scope of premium private medical institutions was first defined. Then, seven indicators were used to analyze the allocation of resources;two indicators were used to analyze services;eight indicators were used to analyze costs. The entire situation of different styles of institutions through 2011 to 2013 was compared. Results:The results indicated that in the allocation of resources, the current level of premium private medical institutions is not high enough;large-scale construction is still at its early stages;and the medical personnel structure is not reasonable enough;as for service quantity, the total growth rate of premium private medical institutions is high but the service quantity is still far below that of the VIP services in public hospitals;as for medical expenses, premium private medi-cal institutions are charging high service fees, and the internal structure of the expenses is reasonable. Conclusions:Although the development of premium private health services is at an early stage, development prospects are promis-ing. Premium private health services should strengthen the aspects of medical technology, service levels, management capabilities, human resource building, and brand development.

OBJECTIVETo determine serum levels of resistin and visfatin in the patients with acute Kawasaki disease before and after intravenous immune globulin (IVIG) treatment.

METHODSA total of 50 children with acute Kawasaki disease were treated with IVIG for 48 hours between January 2011 and January 2013. As controls, 30 healthy children and 30 children with acute infectious diseases were included. Serum levels of resistin and visfatin were measured by ELISA both before and after the treatment.

RESULTSThe baseline serum levels of resistin and visfatin were significantly higher in patients with acute Kawasaki disease than in the two control groups of subjects (i.e., healthy children and patients with acute infectious diseases; P<0.05). In the 50 patients with Kawasaki disease, 38 were not responding and 12 were responding. Serum resistin levels before treatment were significantly higher in non-responders than those in responders (P<0.05). A significant decrease in serum levels of resistin after treatment was observed in IVIG responders (P<0.05). Serum visfatin levels were not significantly different between IVIG responders and non-responders (P>0.05). Additionally, serum resistin and visfatin levels were not significantly different between acute Kawasaki disease patients with and without coronary artery lesions.

CONCLUSIONSResistin and visfatin may play important roles in the development of Kawasaki disease and serum resistin may be used as a novel outcome indicator of the IVIG treatment.

Acute Disease ; Child, Preschool ; Cytokines ; blood ; Female ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome ; blood ; drug therapy ; Nicotinamide Phosphoribosyltransferase ; blood ; Resistin ; blood

This study was aimed to investigate the genetic characteristics, identification method and transfusion strategy of rare blood type B(A). The rare blood group B(A) was typed by serological technique, PCR-SSP genotyping and sequencing of exon 6, 7 of ABO blood group. The genetic characteristics and molecular mechanism of B(A) blood group were also analyzed. Blood group compatibility test was conducted between blood donors of B(A) and recipients by clinical transfusion. The results showed that both forward and reverse grouping did not match the 3 cases of serological result in their family survey, while all of the 3 cases were grouped as AB blood group by forward grouping, B blood group by reverse grouping with serological result and B(A)04/001 group were genotyped by ABO genotyping. The patient of B blood group was transfused by 1 bag of washed red blood cells of donor of B(A) under closely monitoring, the patient's condition changed, and a mild adverse transfusion reaction was appeared. Washed red blood cell of O blood group was transfused into B(A) patient without blood transfusion reaction. It is concluded that the forward ABO serological grouping and reverse ABO serological grouping are not compatible, that may be verified by family survey and molecular biological methods. If in some cases transfusion therapy was applied, and group B(A) can not be transfused to the patient with group B or AB. Thus, transfusion compatibility or autologous transfusion can be adopted to transfuse to the patient from group B(A).
ABO Blood-Group System ; genetics ; immunology ; Adult ; Base Sequence ; Blood Grouping and Crossmatching ; Genotype ; Humans ; Male ; Transfusion Reaction

Objective To evaluate the value of positron emission tomography(PET)-CT imaging combined with continual detection of CA_(125)in serum for diagnosis of early recurrent ovarian epithelial carcinoma.Methods Twenty six patients received PET-CT imaging,who were all diagnosed as primary epithelial ovarian cancer of stage Ⅱ-Ⅳ and had complete remission after cytoreductive surgery and multiple courses of chemotherapy in Shandong Provincial Cancer Hospital.After a steady period,all patients experienced progressive rising of CA_(125)values 3 times in 2 months.But no positive lesion was found by CT, or although suspicious positive focus was found,the recurrent and(or)metastatic extent was not definite. Out of 26 patients,16 were delivered rechemotherapy and(or)radiotherapy,and 10 received re- cytoreductive surgery.Results(1)Of 26 patients,the value of CA_(125)was more than 35 kU/L in 17,and in 14 of 17,pelvic or abdominal cavity recurrence was diagnosed by CT and PET-CT,and 4 showed simuhaneously distant metastasis on PET-CT.In the remaining 3 patients of which CT findings were negative,2 had pelvic and abdominal cavity recurrence,and one had bone metastasis on PET-CT.Of 9 patients with progressive rising CA_(125)levels but the value was less than cut-off(